Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ASW100863 | CA |
NPI | 1003487240 |
---|---|
Provider Name | Lucas Nelson |
First Address | Oxnard, CA 93036-0673 |
Second Address | Oxnard, CA 93036-0673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |